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Review
. 2018 Mar-Apr;60(6):600-606.
doi: 10.1016/j.pcad.2018.03.002. Epub 2018 Mar 10.

Peri-Procedural Management of Oral Anticoagulants in the DOAC Era

Geoffrey D Barnes  1 , Erin Mouland  2
Affiliations
Review

Peri-Procedural Management of Oral Anticoagulants in the DOAC Era

Geoffrey D Barnes et al. Prog Cardiovasc Dis. 2018 Mar-Apr.

Abstract

Peri-procedural management of oral anticoagulants can be complex and confusing for many providers. It involves a careful balance of a patient's thromboembolic risk and bleeding risk. For every patient chronically taking an oral anticoagulant who will be undergoing an elective procedure, a four step approach may be considered when creating a plan for the oral anticoagulant. (1) Does the oral anticoagulant need to stop for the procedure? (2) If yes, when should the oral anticoagulant be stopped pre-procedure? (3) Does the patient require a "bridging" parenteral anticoagulant? (4) When should anticoagulation be re-started post procedure? Based on the unique features of warfarin versus the direct oral anticoagulants (DOAC), a unique, personalized plan should be developed and tailored to the individual patient. Anticoagulant specialists, such as anticoagulation clinic pharmacists, may help facilitate this process.

Keywords: Direct oral anticoagulant (DOAC); Oral anticoagulant; Peri-procedural management; Warfarin.

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